Operate, actions

Actions

Downstream actions derived from the resolved identities. Proposed actions wait for an operator; suppressed actions wait for a steward decision.

Eligibility engine
1,339
Eligibility conflict resolved
1,339 proposed
Claims processor
9,112
Orphan claim re-pointed
9,112 executed
Outreach
7,319
Outreach address corrected, Outreach suppressed pending steward
2,993 proposed4,326 held
Next-best-action
3,896
Care coordination outreach, New member onboarding
3,896 proposed
Member services
4,974
Duplicate member record retired
4,974 executed

Actions

26,640 derived from the last resolution run

TypeAllOrphan claim re-pointed9,112
StatusAllProposed8,228Executed14,086Held4,326Released0
ActionTypeTitleDetailLinked toStatusExecuted
ACT-002590
Orphan claim re-pointed
Claims processor
CLM-414228 → UHC-88973-05 (Jesse Reyes)
Member id
UHC-88973-05
Confidence
0.94
Method
probabilistic
MBR-009347CLM-414228
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002591
Orphan claim re-pointed
Claims processor
CLM-404597 → UHC-74176-39 (Gay Hansen)
Member id
UHC-74176-39
Confidence
0.97
Method
deterministic
MBR-022718CLM-404597
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002592
Orphan claim re-pointed
Claims processor
CLM-428924 → UHC-50088-36 (Frank Woods)
Member id
UHC-50088-36
Confidence
0.97
Method
deterministic
MBR-043538CLM-428924
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002593
Orphan claim re-pointed
Claims processor
CLM-430043 → UHC-98864-36 (Mei Walsh)
Member id
UHC-98864-36
Confidence
1
Method
probabilistic
MBR-018523CLM-430043
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002594
Orphan claim re-pointed
Claims processor
CLM-401058 → UHC-17944-90 (Charles Hunter)
Member id
UHC-17944-90
Confidence
1
Method
probabilistic
MBR-009945CLM-401058
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002595
Orphan claim re-pointed
Claims processor
CLM-417727 → UHC-36471-89 (Logan Yang)
Member id
UHC-36471-89
Confidence
1
Method
probabilistic
MBR-001834CLM-417727
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002596
Orphan claim re-pointed
Claims processor
CLM-431950 → UHC-02686-18 (Michael Kim)
Member id
UHC-02686-18
Confidence
1
Method
probabilistic
MBR-014632CLM-431950
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002597
Orphan claim re-pointed
Claims processor
CLM-429309 → UHC-31006-41 (Julia Thomas)
Member id
UHC-31006-41
Confidence
1
Method
probabilistic
MBR-005836CLM-429309
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002598
Orphan claim re-pointed
Claims processor
CLM-416421 → UHC-97338-53 (Jean Ortega)
Member id
UHC-97338-53
Confidence
1
Method
probabilistic
MBR-009896CLM-416421
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002599
Orphan claim re-pointed
Claims processor
CLM-408903 → UHC-27788-70 (Marcus Snyder)
Member id
UHC-27788-70
Confidence
1
Method
probabilistic
MBR-013543CLM-408903
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002600
Orphan claim re-pointed
Claims processor
CLM-407376 → UHC-46306-19 (Diana Jacobs)
Member id
UHC-46306-19
Confidence
1
Method
probabilistic
MBR-015575CLM-407376
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002601
Orphan claim re-pointed
Claims processor
CLM-425201 → UHC-86751-24 (Jean Gonzales)
Member id
UHC-86751-24
Confidence
1
Method
probabilistic
MBR-029861CLM-425201
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002602
Orphan claim re-pointed
Claims processor
CLM-400667 → UHC-05200-44 (Brandon Carlson)
Member id
UHC-05200-44
Confidence
1
Method
probabilistic
MBR-018558CLM-400667
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002603
Orphan claim re-pointed
Claims processor
CLM-410215 → UHC-94532-50 (Gary West)
Member id
UHC-94532-50
Confidence
1
Method
probabilistic
MBR-000246CLM-410215
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002604
Orphan claim re-pointed
Claims processor
CLM-420628 → UHC-95518-50 (Stephanie Ross)
Member id
UHC-95518-50
Confidence
0.99
Method
probabilistic
MBR-000350CLM-420628
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002605
Orphan claim re-pointed
Claims processor
CLM-422817 → UHC-88098-43 (Cheryl Barnes)
Member id
UHC-88098-43
Confidence
1
Method
probabilistic
MBR-017169CLM-422817
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002606
Orphan claim re-pointed
Claims processor
CLM-401567 → UHC-32594-17 (Mei Sullivan)
Member id
UHC-32594-17
Confidence
1
Method
probabilistic
MBR-029899CLM-401567
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002607
Orphan claim re-pointed
Claims processor
CLM-407117 → UHC-06338-10 (Sharon Rogers)
Member id
UHC-06338-10
Confidence
0.97
Method
deterministic
MBR-032035CLM-407117
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002608
Orphan claim re-pointed
Claims processor
CLM-418504 → UHC-77781-56 (Ralph Montgomery)
Member id
UHC-77781-56
Confidence
1
Method
probabilistic
MBR-006999CLM-418504
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002609
Orphan claim re-pointed
Claims processor
CLM-404820 → UHC-77984-19 (Steven Estrada)
Member id
UHC-77984-19
Confidence
1
Method
probabilistic
MBR-018073CLM-404820
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002610
Orphan claim re-pointed
Claims processor
CLM-403246 → UHC-66774-91 (Kenneth Martinez)
Member id
UHC-66774-91
Confidence
1
Method
probabilistic
MBR-016078CLM-403246
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002611
Orphan claim re-pointed
Claims processor
CLM-401832 → UHC-16187-17 (Ryan Brooks)
Member id
UHC-16187-17
Confidence
1
Method
probabilistic
MBR-006907CLM-401832
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002612
Orphan claim re-pointed
Claims processor
CLM-408865 → UHC-20763-80 (Michelle Bowman)
Member id
UHC-20763-80
Confidence
1
Method
probabilistic
MBR-014576CLM-408865
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002613
Orphan claim re-pointed
Claims processor
CLM-429324 → UHC-62701-47 (Jordan Robertson)
Member id
UHC-62701-47
Confidence
1
Method
probabilistic
MBR-032746CLM-429324
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002614
Orphan claim re-pointed
Claims processor
CLM-406036 → UHC-76599-05 (Larry Barnes)
Member id
UHC-76599-05
Confidence
0.99
Method
probabilistic
MBR-024690CLM-406036
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002615
Orphan claim re-pointed
Claims processor
CLM-431792 → UHC-80014-17 (Diego Porter)
Member id
UHC-80014-17
Confidence
1
Method
probabilistic
MBR-002808CLM-431792
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002616
Orphan claim re-pointed
Claims processor
CLM-412137 → UHC-35606-69 (Catherine Willis)
Member id
UHC-35606-69
Confidence
0.98
Method
probabilistic
MBR-017248CLM-412137
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002617
Orphan claim re-pointed
Claims processor
CLM-427918 → UHC-13847-83 (Diego Ray)
Member id
UHC-13847-83
Confidence
1
Method
probabilistic
MBR-010093CLM-427918
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002618
Orphan claim re-pointed
Claims processor
CLM-409909 → UHC-84332-87 (Jordan Fowler)
Member id
UHC-84332-87
Confidence
1
Method
probabilistic
MBR-003834CLM-409909
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002619
Orphan claim re-pointed
Claims processor
CLM-424885 → UHC-64131-81 (Kelly Carpenter)
Member id
UHC-64131-81
Confidence
1
Method
probabilistic
MBR-005648CLM-424885
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002620
Orphan claim re-pointed
Claims processor
CLM-409694 → UHC-88199-27 (Carlos Chavez)
Member id
UHC-88199-27
Confidence
1
Method
probabilistic
MBR-002793CLM-409694
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002621
Orphan claim re-pointed
Claims processor
CLM-406960 → UHC-40675-56 (Nicole Daniels)
Member id
UHC-40675-56
Confidence
1
Method
probabilistic
MBR-024637CLM-406960
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002622
Orphan claim re-pointed
Claims processor
CLM-425080 → UHC-20983-31 (Peter Smith)
Member id
UHC-20983-31
Confidence
1
Method
probabilistic
MBR-027791CLM-425080
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002623
Orphan claim re-pointed
Claims processor
CLM-415367 → UHC-75069-05 (Daniel Warren)
Member id
UHC-75069-05
Confidence
0.97
Method
deterministic
MBR-015842CLM-415367
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002624
Orphan claim re-pointed
Claims processor
CLM-430227 → UHC-66078-28 (Aisha Gray)
Member id
UHC-66078-28
Confidence
0.93
Method
probabilistic
MBR-022080CLM-430227
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002625
Orphan claim re-pointed
Claims processor
CLM-426714 → UHC-34406-02 (Patricia Hicks)
Member id
UHC-34406-02
Confidence
1
Method
probabilistic
MBR-028080CLM-426714
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002626
Orphan claim re-pointed
Claims processor
CLM-413566 → UHC-50765-80 (Kathryn Martin)
Member id
UHC-50765-80
Confidence
1
Method
probabilistic
MBR-027411CLM-413566
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002627
Orphan claim re-pointed
Claims processor
CLM-426179 → UHC-26224-70 (Jose Hunter)
Member id
UHC-26224-70
Confidence
0.99
Method
probabilistic
MBR-000947CLM-426179
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002628
Orphan claim re-pointed
Claims processor
CLM-425593 → UHC-44943-48 (Sandra Davis)
Member id
UHC-44943-48
Confidence
0.97
Method
deterministic
MBR-021852CLM-425593
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002629
Orphan claim re-pointed
Claims processor
CLM-405239 → UHC-84143-49 (Anthony Guerrero)
Member id
UHC-84143-49
Confidence
0.98
Method
probabilistic
MBR-006507CLM-405239
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002630
Orphan claim re-pointed
Claims processor
CLM-410917 → UHC-81632-20 (Teresa Payne)
Member id
UHC-81632-20
Confidence
1
Method
probabilistic
MBR-005314CLM-410917
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002631
Orphan claim re-pointed
Claims processor
CLM-420378 → UHC-36461-68 (Sandra Reyes)
Member id
UHC-36461-68
Confidence
1
Method
probabilistic
MBR-018376CLM-420378
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002632
Orphan claim re-pointed
Claims processor
CLM-400276 → UHC-92974-96 (Alexander Medina)
Member id
UHC-92974-96
Confidence
1
Method
probabilistic
MBR-015167CLM-400276
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002633
Orphan claim re-pointed
Claims processor
CLM-419285 → UHC-03266-71 (Amber Munoz)
Member id
UHC-03266-71
Confidence
1
Method
probabilistic
MBR-011086CLM-419285
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002634
Orphan claim re-pointed
Claims processor
CLM-431822 → UHC-99457-20 (Jess Henderson)
Member id
UHC-99457-20
Confidence
1.00
Method
probabilistic
MBR-010508CLM-431822
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002635
Orphan claim re-pointed
Claims processor
CLM-423051 → UHC-16447-67 (Ralph Washington)
Member id
UHC-16447-67
Confidence
1
Method
probabilistic
MBR-003071CLM-423051
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002636
Orphan claim re-pointed
Claims processor
CLM-415973 → UHC-40173-47 (Christina Bishop)
Member id
UHC-40173-47
Confidence
1
Method
probabilistic
MBR-003095CLM-415973
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002637
Orphan claim re-pointed
Claims processor
CLM-405446 → UHC-69418-07 (Cheryl Hill)
Member id
UHC-69418-07
Confidence
1
Method
probabilistic
MBR-017412CLM-405446
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002638
Orphan claim re-pointed
Claims processor
CLM-411704 → UHC-50301-63 (Zachary Henry)
Member id
UHC-50301-63
Confidence
0.98
Method
probabilistic
MBR-031842CLM-411704
Executed
resolution_agent
2026-10-22 12:47:23
ACT-002639
Orphan claim re-pointed
Claims processor
CLM-424754 → UHC-17288-43 (Scott Singh)
Member id
UHC-17288-43
Confidence
1
Method
probabilistic
MBR-010664CLM-424754
Executed
resolution_agent
2026-10-22 12:47:23
9,112 rows, page 26 of 183PreviousNext

Derivation rules

Evaluated after every gold rebuild

  1. 1
    Eligibility conflict resolved
    The records behind one identity disagree on plan code. Survivorship picks the enrollment plan; the eligibility engine is told which one is canonical.
  2. 2
    Orphan claim re-pointed
    A claim arrived without a member ID. Resolution attached it to an identity that has one, so the claims processor can now pay it against the right member.
  3. 3
    Outreach address corrected
    The most recent address on the golden record differs from what enrollment holds. Outreach gets the current address before the next mailing.
  4. 4
    Outreach suppressed pending steward
    The record is sitting in an open steward case. Nothing sensitive is sent until a person decides, so we never message the wrong member.
  5. 5
    Care coordination outreach
    Three or more claims and no provider record. Next-best-action proposes assigning a PCP and scheduling a care-coordination call.
  6. 6
    New member onboarding
    A single, fresh enrollment with no other activity yet. Next-best-action proposes the welcome kit and a digital ID card.
  7. 7
    Duplicate member record retired
    Two or more enrollment records collapsed into one identity. Member services retires the extra cards against the surviving member ID.